1265484315 NPI number — WILLIAM S MILLER, MD, PC

Table of content: (NPI 1265484315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265484315 NPI number — WILLIAM S MILLER, MD, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM S MILLER, MD, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265484315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 S PRESTON ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANSON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25438-1675
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-725-6514
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 S PRESTON ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RANSON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25438-1675
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-725-6514
Provider Business Practice Location Address Fax Number:
304-725-3781
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
SMITH
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
304-725-6514

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001721157 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 0056320000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0489491 . This is a "PTAN" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 822511 . This is a "MAMSI/UNITED HEALTHCARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 12485 . This is a "WV STATE LICENCE NUMBER" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 410113203 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 4503451 . This is a "AETNA" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




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